DIABETES IN SCHOOL

1. DIABETES IN SCHOOL WHAT EVERY EDUCATOR SHOULD KNOW…….

2. IDEA – Public Law 94-142Student Rights • Free and appropriate Public Education • Least restrictive environment • Eligible students receive services to meet their individual needs (IEP) • Diabetes classified as “Other Health Impairment”

3. Rehabilitation Act – Section 504 • Protects persons with disabilities from being excluded from participation in any program or activity receiving federal funding • A 504 plan may be written to specifically state the accommodations necessary to meet the student’s needs at school

4. Texas State House Bill 984 • Applies to campus with diabetic students • Principal designates 3 campus employees (who are not healthcare professionals) to serve as Unlicensed Diabetic Care Assistants (UDCA) • School nurse provides training to the UDCA

5. House Bill 984 (cont’d)UDCA Training • Treatment of high and low blood sugar • Testing of blood glucose and ketones • Administration of glucose gel, glucagon, and insulin • Management of Student’s Individualized Healthcare Plan (IHP)

6. What is Diabetes? • Diabetes is a serious, chronic disease that impairs the way the body uses food (specifically sugar/glucose) • Insulin, a hormone produced by the pancreas, helps the body convert food into energy • In diabetes, the pancreas does not make insulin (Type I) or cannot use the insulin properly (Type II)

7. What is Diabetes? • Insulin deficiency or inefficiency causes the blood sugar level to be too high or too low • Diabetes cannot be cured, only managed • Diabetics must carefully balance food, medication and activity levels to keep the blood sugar as close to normal as possible • Low blood sugar and high blood sugar can be life threatening

8. Type I Pancreas does NOT produce insulin Must receive insulin through injections or a pump (Insulin Dependent) Most common type afflicting school-age children Causes: genetic or autoimmune post infection Type II Insulin is overproduced by the pancreas, and receptor cells become resistant May be controlled with diet and exercise May require oral medication (i.e. glucophage) and/or injections of insulin Obesity is a high risk factor, as is over consumption of sugars In past, usually onset is late adulthood Recently, children have become afflicted Types of Diabetes

9. Diabetic Management at School • The student may have to visit the nurse at scheduled times for blood testing and/or insulin injections as well as urine testing • It is the responsibility of the teacher, student, teacher and nurse to ensure testing and/or medications are administered on time • Special arrangements should be made in the event of field trips or class parties to ensure that a UDCA accompanies the student

10. Diabetic Management at School • It may be necessary for a diabetic student to eat a snack in the classroom to maintain adequate blood sugar levels • Depending on maturity, blood sugar testing may be performed in the classroom • Insulin will generally be administered in the clinic • Some students have insulin pumps which automatically administer calculated amounts of insulin, and additional amount (bolus) of insulin can be given without giving the student a “shot”

11. Diabetic Management at School • The student may need special scheduling for lunch and must be allowed adequate time to finish all meals • The student may require quick acting sugar to be available at all times • The student may require a free access to water, and may carry a water bottle • The student will require free access to the restroom

12. Caused when the body gets too much insulin, too little food, a delayed meal, or more exercise than usual Symptoms Sweating Impaired Vision Weakness/Fatigue/Sleeping in Class Headache Light-headedness Irritability Anxious Confusion/Inability to follow directions Hunger Shakiness/Fainting Fast Heartbeat HYPOglycemia ( LOW blood sugar)

13. Occurs when the body gets too little insulin, too much food, or too little exercise May also be caused by stress or illness SYMPTOMS: Excessive thirst Frequent urination Blurry vision Fast heart rate, rapid breathing Nausea/vomiting Hunger Dry Skin Drowsiness HYPERglycemia (HIGH Blood Sugar)

14. Hyperglycemia can lead to Ketoacidosis! • Ketoacidosis means dangerously high levels of acids that build up in the blood, upsetting the chemical balance • Ketones appear in the urine when your body does not have enough insulin and is breaking down fat for energy • Ketones can also appear when a diabetic is ill (i.e. with a cold/flu) • Ketoacidosis can lead to diabetic coma or even death; it will be treated in the hospital

15. Treatment of Symptoms • Always allow a student with symptoms to go to the nurse immediately • Never allow a student with symptoms to go to the clinic by him/herself • Only staff members who are trained in diabetes management should treat a symptomatic student • Hypoglycemia will be treated with glucose tablets, gel, juice/snacks or soda according to the student’s IHP • Hyperglycemia will be treated with insulin administered by a nurse or trained UDCA only

16. EMERGENCY CARE • HYPOglycemia and HYPERglycemia can both be potentially life threatening and must be treated immediately • 9-1-1 and Trained Staff members should be contacted immediately • Hypoglycemia may cause unconsciousness or seizures and may be treated with Glucagon administered by nurse or UDCA

17. Your Student With Diabetes • Will have an Individualized Health Plan, specific to his/her diabetes management • Will have specific instructions for emergency care management • Will have specific equipment/supplies/snacks

18. What YOU need to do • Meet with the school nurse to obtain specific information about students with diabetes under your instruction or supervision and attend training • Read the accompanying attached handout “A Guide to Diabetes in the School” • Inform you school nurse at least 2 weeks prior to any off-campus trips or activities

19. What YOU need to do • Clip the handout to your grade/attendance book for your substitute’s reference • Always keep fast acting sugars such as hard candy/juice or sodas available • Please ask for clarification about Diabetes and the management of a diabetic student from your school nurse

20. Other Misc Info • Diabetes diet…Just as any other person, the diabetic should eat a well balanced, healthy diet from a variety of food sources • Type I Diabetics are not restricted from eating candy or high sugar foods, but as with any child, it should not be a significant source of their diet and all sugars need to be managed with insulin • All Carbohydrates (Carbs) contain sugars

21. Carbohydrate Counting Calories in food give the body energy through nutrients: • Carbohydrates • Protein • Fat Each nutrient affects blood sugar differently

22. Carbohydrate Counting • Total carbohydrates is what is used to determine how much insulin is needed • Another component of carbohydrate monitoring is whether the “carb” is slow acting or fast acting • Fast Acting Carbohydrates are absorbed quickly into the bloodstream • Slow Acting Carbohydrates are absorbed over a longer period of time

23. Rapid vs Slow Acting Carbs Rapid acting carbohydrates • Will usually be absorbed within minutes and be absorbed (gone) from the bloodstream within one hour • Typically contain only sugars: examples hard candy, juice, soda, gel frosting

24. Slow Acting Carbohydrates • Onset of absorption is slower and over a longer period of time (hours) • Comprised of starchy sugars or sugars combined with other nutrients such as protein or fat…examples include candy bars, peanut butter, fruits, bread, ice cream….

25. Rapid vs. Slow Carbs (cont’d) • Rapid acting is needed when blood sugar is low (Below 80) so the blood sugar does not continue to decline • Slow acting carbs are needed to keep the blood sugar from dropping between meal times

26. Diabetes other facts • Student with diabetes are often on various types of insulin • Student growth patterns also impact the body’s management of insulin and blood sugar • Diabetes can be unpredictable • Parents and students need our support

27. Thank you for attending training on Diabetes!